• Journal of Korean Academy of Nursing Administration
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• v.2 no.1
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• pp.97-114
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• 1996

INSTRODUCTION Service quality is, unlike goods quality, an abstract and elusive constuct. Service quality and its requirements are not easily understood by consumers, and also present some critical research problems. However, quality is very important to marketers and consumers in that it has many strategic benefits in contributing to profitability of marketing activities and consumers' problem-solving activities. Moreover, despite the phenomenal growth of medical service sector, few researchers have attempted to define and model medical service quality. Especially, little research has focused on the evaluation of medical service quality and patient satisfaction from the perspectives of both the provider and the patient. As competition intensifies and patients are demanding higher quality of medical service, medical service quality and patient satisfaction has emerged as a critical research topic. The major purpose of this article is to explore the concept of medical service quality and its evaluation from both nurse and patient perspectives. This article attempts to achieve its purpose by (1)classfying critical service attibutes into threecategories(satisfiers, hygiene factors, and performance factors). (2)measuring the relative importance of need criteria, (3)evaluating SERVPERF model and SERVQUAL model in medical service sector, and (4)identifying the relationship between perceived quality and overall patient satisfaction. METHOD Data were gathered from a sample of 217 patients and 179 nurses in Seoul-area general hospitals. From the review of previous literature, 50 survey items representing various facets of the medical service quality were developed to form a questionnaire. A five-point scale ranging from "Strongly Agree"(5) to "Strongly Disagree"(1) accompanied each statement(expectation statements, perception statements, and importance statements). To measure overall satisfaction, a seven-point scale was used, ranging from "Very Satisfied"(7) to "Very Dissatisfied"(1) with no verbal labels for scale points 2 through 6 RESULTS In explaining the relationship between perceived performance and overall satisfaction, only 31 variables out of original 50 survey items were proven to be statistically significant. Hence, a penalty-reward analysis was performed on theses 31 critical attributes to find out 17 satisfiers, 8 hygiene factors, and 4 performance factors in patient perspective. The role(category) of each service quality attribute in relation to patient satisfaction was com pared across two groups, that is, patients and nurses. They were little overlapped, suggesting that two groups had different sets of 'perceived quality' attributes. Principal components factor analyses of the patients' and nurses' responses were performed to identify the underlying dimensions for the set of performance(experience) statements. 28 variables were analyzed by using a varimax rotation after deleting three obscure variables. The number of factors to be extracted was determined by evaluating the eigenvalue scores. Six factors wereextracted, accounting for 57.1% of the total variance. Reliability analysis was performed to refine the factors further. Using coefficient alpha, scores of .84 to .65 were obtained. Individual-item analysis indicated that all statements in each of the factors should remain. On 26 attributes of 31 critical service quality attributes, there were gaps between actual patient's importance of need criteria and nurse perceptions of them. Those critical attributes could be classified into four categories based on the relative importance of need criteria and perceived performance from the perspective of patient. This analysis is useful in developing strategic plans for performance improvement. (1) top priorities(high importance and low performance) (in this study)- more health-related information -accuracy in billing - quality of food - appointments at my convenience - information about tests and treatments - prompt service of business office -adequacy of accommodations(elevators, etc) (2) current strengths(high importance and high performance) (3)unnecessary strengths(low importance and high performance) (4) low priorities(low importance and low performance) While 26 service quality attributes of SERPERF model were significantly related to patient satisfation, only 13 attributes of SERVQUAL model were significantly related. This result suggested that only experience-based norms(SERVPERF model) were more appropriate than expectations to serve as a benchmark against which service experiences were compared(SERVQUAL model). However, it must be noted that the degree of association to overall satisfaction was not consistent. There were some gaps between nurse percetions and patient perception of medical service performance. From the patient's viewpoint, "personal likability", "technical skill/trust", and "cares about me" were most significant positioning factors that contributed patient satisfaction. DISCUSSION This study shows that there are inconsistencies between nurse perceptions and patient perceptions of medical service attributes. Also, for service quality improvement, it is most important for nurses to understand what satisfiers, hygiene factors, and performance factors are through two-way communications. Patient satisfaction should be measured, and problems identified should be resolved for survival in intense competitive market conditions. Hence, patient satisfaction monitoring is now becoming a standard marketing tool for healthcare providers and its role is expected to increase.

• The Korean Nurse
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• v.31 no.4
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• pp.77-99
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• 1992

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.

• Women's Health Nursing
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• v.4 no.1
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• pp.161-178
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• 1998

In spite of the great progress of the theory and skill of the Nursing Care & Medical area in relation to pregnancy, nurses in clinics face up to many challenges in maternity nursing care areas. The reason is that the mobility and mortality of mothers was sharply decreased and the unknown high-risk diseases of pregnancy woman in the past is made public. That's why it is difficult to meet the pregnancy woman in natural process from pregnancy to delivery in recently. Admission rooms are filled with high-risk pregnancy women. As a matter of fact, we have done nursing care into the surface symptoms and diseases of high-risk pregnancy women so far. We have been indifferent to a long period hospitalization, separation from family, and conflict of repeated examination. Therefore, it is widely spread to understand the emotional conflict experienced by high-risk pregnancy women and to need for nursing intervention to bring up about emotional support and the ability of perception in psychological crisis. Although the pregnancy woman judged in high-risk should carry out normal task of pregnancy, she have to be confronted with secondary risk situation. The health of self & fetus threatened by the risk situation could be decreased through care plan, but psychological stress increases. Therefore, the pregnancy brings into non-control state. It is important to ask that what the hospitalized pregnancy women in high-risk think of themselves status. Because misunderstanding or serious anxiety of themselves status put into mother and fetus in danger. And adaptation mode makes all the difference. I would like to consider how nurses could deal with this high-risk circumstances in the position of pregnancy woman on the basis of the above fact. This study uses phenomenological method to suggest the basis material for nurses to do nursing intervention in view of pregnancy woman. Because this method understands the nature of true life of pregnancy woman throughly. The phenomenological method is the sources to describe or explain affluently the process generated in confirmation areas and environment and is the application for readers to understand and recognize clinic reality and then apply this method to reasoning study place or other places. Specifically, the phenomenon study method, one of the phenomenological method, is applied. The use of that method is to describe and generalize the experience in environment exactly. The study of this study is as follows : Among 187 descriptive stamens from 8 study participants are classified into 42 theme cluster at the stage of the first analysis. Those theme is categorized into 8 sub-subjects such as anxiety of uncertainty, foreknowledge about risk circumstance, will power about overcome, unsettled feeling about hospital, relief, optimistic thought, family support, and indifferences. At the last stage of analysis, those things are categorized into 3 subjects. When high-risk pregnancy woman foretell the situation, they feel unsettlement about uncertainty and untrust feeling about hospital. But they are ease with family support and hospital support. On the other hand, they express indifferent 3-way structure response to the situation having will of overcome and exceeding optimistic thought. In those statements, the experience by pregnancy woman shows 3 respect subjects. 1. They are anxious of this situation and are in desperation and don't recognize their role to be carried out 2. They think of this situation as normal process of pregnancy and are not concerned that this can give themselves and fetus fatal damage. 3. The pregnancy women will never confront this situation. This study shows the pregnancy woman has anxiety and optimistic relief about the situation, and ignores and optimistic relief about the situation, and ignores many things. Therefore, nurses in clinic should give pregnancy woman knowledge and information about the high-risk and help them to deal with the situation spontaneously. High-risk pregnancy woman should have the care plan in respect of the right perception. And the nurse know that their support help out pregnancy woman overcome the crisis in this respect of the special nursing intervention.

• Journal of Yeungnam Medical Science
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• v.39 no.2
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• pp.116-123
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• 2022

Background: Recently, there have been various developments in medical service robots (MSRs). However, few studies have examined the perceptions of those who use it. The purpose of this study is to identify user perceptions of MSRs. Methods: We conducted a survey of 320 patients, doctors, and nurses. The contents of the survey were organized as follows: external appearances, perceptions, expected utilization, possible safety accidents, and awareness of their responsibilities. Statistical analyses were performed using t-test, chi-square test, and analysis of variance. Results: The most preferred appearance was the animal type, with a screen. The overall average score of positive questions was 3.64±0.98 of 5 points and that of negative questions was 3.24±0.99. Thus, the results revealed that the participants had positive perceptions of MSR. The overall average of all expected utilization was 4.05±0.84. The most expected utilization was to guide hospital facilities. The most worrisome accident was exposure to personal information. Moreover, participants thought that the overall responsibility of the robot user (hospital) was greater than that of the robot manufacturer in the case of safety accidents. Conclusion: The perceptions of MSRs used in hospital wards were positive, and the overall expected utilization was high. It is necessary to recognize safety accidents for such robots, and sufficient attention is required when developing and manufacturing robots.

• The Journal of Korean Society for Radiation Therapy
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• v.13 no.1
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• pp.1-13
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• 2001

I. Purpose This study is performed to encourage cancer patients to identify, relieve and effectively overcome the stress caused by radiotherapy, by analyzing stress reactions and coping patterns of cancer patients who perceived stress due to radiotherapy. II. Materials & Methods The study group was composed of 85 cancer patients of the age 20 or higher who were undergoing radiotherapy in four hospitals located in Seoul and Kyonggi-do. The survey questionnaire was used, which had 161 questions inquiring respondents of general status, perceived stress, stress reactions and coping patterns. The surveyed data were analyzed by a SAS program, which employed descriptive statistics. Pearson Correlation Coefficient, t-test, ANOVA and Stepwised Multiple Regression. III. Results The stress perception and reaction rates were low in cancer patients comparing to patients of the other study. In the coping patterns. the problem-focused coping patterns were significantly higher than emotion-focused coping patterns. The statistically meaningful differences were observed in the stress perception and reactions depending on the time of diagnosis and perceived health level. As for the problem-focused coping patterns, significant differences were found depending on age, marital status, education, income and the number of family members as well as perceived health level of patients. The level of perceived stress and that of stress reactions was found to have positively significant correlation(r=.764, p<.001) while the perceived stress and the problem-focused coping patterns was correlated negatively (r=-.288, p<.01). The stress reactions and the problem-focused coping patterns was found to have negatively significant correlation(r=-.289, p<.01). IV. Conclusion The problem-focused coping behavior, which cooperated with doctors, technologists, nurses and families of cancer patients, is advisable for the cancer patients to overcome uncertainty and uneasiness by effectively release the stress.

• Journal of Korean Academy of Nursing
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• v.25 no.4
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• pp.807-824
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• 1995

This study was intended to provide women who are experiencing menopause with effective nursing care by exploring the menopause experience. The purpose of the research was to understand the subjective feelings of women about the question of what the menopause experience is. Q-Methodological method was used for that purpose. As the research method, Q-statements were collected preliminary to the study of through in -depth interviews and a literature review. For the study 34 Q-statements were selected. There were 21 women as subjects for the research. The 21 women sorted the 34 statements using the principle of Forced Normal Distribution. The principle of Forced Normal Distribution, which has nine scales to measure the individual opinions, was called Q-Factor Analysis by using PC Quanl Program to supply the material. As a result, there were four categories(self-com-passion type, self-regulation type, self-perception type, self-abandonment type) of special opinion about the menopause experience in these women. The first type was called Self-compassion This type' was associated with varying degrees of emotonal instability(psychological withdrawal). And type in menopause signifies loss of a socially valued status and may result in depressive symptoms. This type expresses the menopause experience as associated with negative reaction. The second type is called Self-regulation. This type overcomes the menopause experience more actively than the other types and do not express the menopause experience as one of suffering. This type make efforts by themselves to regulate the mono-pause experience. The third type is called Self-perception. This type perceives the experience of menopause which as typical menopausal syndrome (hot flashes and decreased vaginal lubrication, decreased estrogen producing atrophic changes of the labia and vaginal mucosa, making intercourse uncomfortable). The fourth type is called Self- abandonment. This type denies the experience of menopause. The meaning of menopausal experience is significantly related with a life accident or life load. Also, This type experiences pain in the musculoskeletal system. As a result, The meaning of the menopausal experience is affected by perceived subjective experience of the nurses, the need to understand each persons meaning of the menopause experience and to develop appropriate nursing interventions based on the typology of menopause experience. Finally. The result of the study will provide basic data for nursing intervention the menopausal women.

• Journal of Korean Academy of Nursing
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• v.35 no.2
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• pp.252-261
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• 2005

Purpose: The purpose of the study was to investigate the health status(present illness, ADL and IADL), health perception, and health promotion behaviors of low-income elderly who are receiving the visiting nurse service in the community. Method: The sample of the study was 735 elderly over 65years old with basic livelihood security, who were conveniently selected from 245 public health centers nation-wide. Data collection was done using a structured questionnaire through interviews by visiting nurses. Result: The average number of present illnesses in the study subjects was 4.18. The average scores of ADL and IADL were 15.903.39and 9.772.97 respectively, which indicates a relatively independent everyday life. However, $64.2\%$ of the subjects perceived their health status as 'not healthy'. In terms of health promotion behaviors, $77.8\%$ of the subjects had ceased smoking, $83.9\%$ stopped drinking, $56.4\%$ had a regular diet, $45.8\%$ received regular physical check-ups during the past two years, and $66\%$ received flu shots. Approximately $50\%$ of the subjects were practicing 3-4 health promotion behaviors. Significant factors associated with health promotion behaviors were ADL, IADL and self-efficacy. Conclusion: Health promotion programs which focus on regular diet, exercise, and regular physical check-ups should be developed to improve independence of everyday life and quality of life among low-income elderly.

• The Journal of Korean Academic Society of Nursing Education
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• v.3 no.2
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• pp.193-206
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• 1997

Because the oral mucositis is often inevitable in acute leukemia patients during chemotherapy, the efforts must be made to keep these leukemia patients from oral mucositis. So we tried to develop two oral care protocols for reducing the level of oral mucositis during cytotoxic therapy through literature review and our clinical experience. This quasi-experimental study was performed to compare the prohpylatic value of these oral care protocols. Thirty-nine subjects were assigned to one of three groups. The first group performed bivon-normal saline gargling protocol, the second group performed chlorhexidine gargling protocol, and the last contrast group kept traditonal gargling protocol. The Oral Assessment Guide(OAG), the Beck's perception of oral comfort were used to assess oral status and subject's oral discomfort during chemotherapy. Each subjects were observed daily from the start of the chemotherapy until Absolute Neutrophil Count (ANC) reached $1,000/mm^3$. It continued about 2-4 weeks. The data was analyzed by ANCOVA and Kruskal-Wallis one way ANOVA, chi-sqare, survival analysis. The results were as follows : The contrast group showed significantly highest mean score of the OAG and Beck's perception of oral discomfort among three groups from second week to third week. However chie-test and survial analysis showed that the incidence of severe mucositis were not significantly different among three groups. Conclusively we recommend that nurses who care acute leukmia patients use bivon-normal saline gargling protocol be careful to occur severe mucositis during chemotherapy.

• Journal of Korean Academy of Nursing
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• v.30 no.4
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• pp.956-966
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• 2000

The purpose of this study was to examine the comparative between depression and stress related to life events among women in the menopausal stage. Menopausal stages were divided into two groups: Pre and post-menopausal stages. The degree of depression and stress related to life events between pre and post menopausal women were compared to each other. Women, aged between 41 and 59 years, answered self-reported questionnaires which included Zung's depression scale and life events scale modified by Lee (1984). Findings were as follows; 1) The mean score of premenopausal women who experienced depression was 39.66, and for post-menopausal women the score was 41.45. There was no significant differences in depression levels between pre and post menopausal group.s (t=-1.55, p=.122). 2) Menopausal women experienced low levels of stress related to life events. There were no significant differences between pre and post menopausal groups(t=.527, p>.05). Both pre and post menopausal groups were highly concerned about education issues of their children and disharmony between couples. 3) There was a significant relationship between depression and stress related to life events among post-menopausal groups (r=.22, p<.01). Based on the findings of this study, the menopausal depression was associated with stress related to life events, especially among post-menopausal women. Feelings of lost fertility and feminine attributies result in menopausal depression, which is significantly correlated with women's negative perception of their life events. Therefore, nursing intervention needs to develop to help reduce the levels of depression and overcome their negative perception of the menopausal experience. Nurses should develop nursing strategies to help menopausal women to have positive perceptions and enhance quality of life by assisting their adaptability to physiological and psychological changes related to menopause.

• The Journal of Korean Academic Society of Nursing Education
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• v.27 no.4
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• pp.436-446
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• 2021

Purpose: The purpose of this study was to identify the influences of nursing students perfectionism tendencies and their perception of instructor caring on incivility experienced by nursing students during clinical practice. Methods: A descriptive correlational study was conducted. The participants were 244 nursing students from five universities in B city. Data were analyzed using an independent t-test, ANOVA, Pearson's correlation coefficient, Scheffé test and a stepwise regression analysis. Results: The mean score for incivility in nursing students was 2.61 out of 5 points. The explanatory power of the model for incivility was in nursing students 52.8% of the variance in training in student's university hospital (𝛽=-.15, p=.002), total period of clinical practice (𝛽=.17, p<.001), confidence through caring (𝛽=-.23, p<.001), respectful sharing (𝛽=-.15, p=.005), supportive learning climate (𝛽=-.15, p=.005), self-oriented perfectionism (𝛽=.14, p=.004), and socially prescribed perfectionism (𝛽=.18, p<.001). Conclusion: The research results suggest that instructor caring is an important factor in regard to the incivility of nursing students. Organizational efforts and institutional devices will be needed to improve the incivility in clinical environments. By communicating with students and showing them respect, clinical nurses will help nursing students cope with incivility and recognize the clinical practice education environment positively.